100252 c No. Street Lot No.
o —
u APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO CITY OF CUPERTINO
° WATER DEPT.
U Sanitary No.
E AUG P 1971
196_ Permit No �2 J �
3 RAIQ Fee$ i
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
° A in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
.E laws applicable thereto.
A 1 Use of Premises
° " �1I
° Owner -� ' Address
c m
9 N By Address
Contractor,,Agent
y/
° Phone
State License Approved
Plumbing Inspector
FIXTURES NUMBERNNot
MAIN DRAIN
Units Fees Units Fees
Water Heater
Water Closet ial
Bath Tub urb
Shower Prop. Line
Lavatories xistin
Kitchen ink o n.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink $Fixture
l
Sand TrapOTAL FEES
Urinal Fee
Area Drain rain Fee
Water Leader Drain Fee
Sprinkler System ys. Fee
Relief Valve 11 Gaq Fee
Vac Breaker
Skimmer
Filter
Ele. FeeTotal ee